Flight of mental hospital staff taking a human toll

Head of Atascadero state facility refuses to link suicides to acute loss of workers, but concedes that care is eroding.

Two Atascadero State Hospital patients have killed themselves and four others have attempted suicide since early February -- an alarming surge in such incidents at the Central Coast psychiatric facility that comes as it is rapidly losing key staff to more lucrative jobs in the prison system.

Until February, the facility had not had a suicide since August 2005, and the one before that occurred in 2001. Over the last six years, Atascadero has averaged less than one attempted suicide per month.

The recent spate of deaths and injuries occurred in the weeks after hospital administrators severely curtailed admissions for the first time in the institution's history, concerned that staff shortages were jeopardizing patients' safety.

Atascadero Executive Director Mel Hunter said he couldn't directly tie the suicides to the crisis. But he noted that acute staff shortages are clearly eroding care. To keep wards fully staffed, he said, the hospital has had to rely on overtaxed employees working large amounts of overtime.

"The best way to prevent suicides is to spend time with the men, to develop good clinical relationships," Hunter said. "In an institution running shortages from 52% to 80% on our clinical staff, we are bound to start seeing some bad outcomes."

The two men who died, Matthew Miller and Roland James, had been sent to Atascadero from the California prison system, where mental health care is so poor that a federal judge ruled it unconstitutional. The court ordered reforms, including steep pay raises for clinicians.

But those reforms have contributed to what one legislator called a "death spiral" at Atascadero as psychiatrists and other clinicians have left the facility for much more lucrative prison jobs.

Staff members had already been leaving the hospital, frustrated by relentless mandatory overtime, increasing assaults by patients and orders by the California Department of Mental Health to dramatically change the treatment philosophy. After the court-ordered prison raises, that trickle became a flood. On Jan. 18, Atascadero administrators closed the hospital to all but the most urgent admissions, saying that safety could not be guaranteed.

The prison system only sends its most severely mentally ill inmates to Atascadero, which seeks to adjust their medication, stabilize them and keep them safe. But in the midst of its crisis, the hospital failed some of its patients.

The recent cluster of suicide attempts began Feb. 4, when staffers discovered a gasping patient who had tried to hang himself from his bedroom locker. He survived without serious injury. Then on Feb. 15, Miller, 52, of Lynwood, killed himself using a similar method.

He was deeply despondent, a cousin who grew up with him said, having learned the previous month that he would be kept at Atascadero rather than paroled. Ron Ward, who grew up watching out for his socially vulnerable cousin, wonders why the hospital was not able to prevent the suicide because it was evident from Miller's letters that he was distraught. "Maybe they should have watched him better once they told him that," Ward, 53, said.

The next weekend, a patient overdosed on the antipsychotic drug Seroquel and was hospitalized. Another doused himself in baby oil, wrapped tissue around his body and set himself ablaze, suffering burns.

On the night of March 2, in the same unit where Miller killed himself, James -- a 43-year-old father of four -- hanged himself from his locker with a bedsheet.

A panicked staff member called his mother, Christine James, at her Redding home at 11:30 that night to report that her son had been found without a pulse. Then, concerned about privacy laws, she and other staffers refused to elaborate, leaving the family to call frantically through the night trying to get more information.

Ten days later -- after yet another patient in the same unit unsuccessfully attempted to hang himself -- James was removed from a ventilator. He was brain-dead.

In the weeks before his death, Christine James said, her son seemed to sink into deep despair. He told her he had been placed under intensive monitoring, and then, a few days before he hanged himself, he said the monitoring had been lifted.

"It's hard to accept. Your kids are supposed to outlive you," said Christine James, 62. "It's a mental hospital. I would have thought they would have watched him since they know mental patients are capable of such things." Suicide attempts sometimes come in copycat clusters, and those determined to die can be difficult to thwart.

Still, staffers are dismayed by what some say is the worst series of patient tragedies in recent memory and believe that the staffing crisis contributed. Staff members say that licensed caregivers are in such demand that they are often required to shift to units where they don't know the patients. The problems, they say, are compounded by low morale.